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PAD Diagnosis & Treatment

Should I be tested for PAD?

If you experience any of the symptoms of PAD, see your doctor so that you can be tested.

PAD often does not cause symptoms in the early stages. The only way to detect the disease early is to have regular physical examinations with your doctor, especially if you have characteristics that put you at high risk for PAD (See below, How is PAD Diagnosed?). You should be tested for PAD if:

  • You are 70 or older
  • You are 50 and older and
  • You have other risk factors that put you at high risk for PAD (see Am I at Risk)

How is PAD diagnosed?

The first step in diagnosing PAD is a review of your symptoms and medical history, especially conditions that put you at risk for PAD. Your doctor will also do a physical exam to check for signs of PAD, including:

  • Checking the pulses in your legs and feet to see if there is enough blood flowing
  • Examining the appearance of your legs and feet, including skin color and temperature
  • Checking your legs and feet for slow or non-healing wounds

Your doctor may also perform a simple, painless and reliable test for diagnosing PAD, called the ankle-brachial index, or ABI. This test uses blood pressure cuffs to compare blood pressure in your ankle compared to that in your arms. If your ABI number is low (less blood flow in your legs than your arms) it is a sign that PAD is affecting your leg arteries.

Other tests may also be used to get a better look at the arteries and blood flow in your legs, including:

  • Ultrasound that uses sound waves (like those used to view the fetus when you are pregnant) to produce pictures of your arteries
  • CT angiography or MR angiography, tests that use imaging machines to look at the shape and blood flow in your arteries
  • Contrast angiography of the leg arteries that uses an injected dye to show the shape and blood flow of blood vessels on an x-ray

To learn more, see Overview of PAD Diagnosis.

How is PAD treated?

PAD is treated with a combination of lifestyle changes, medications, and if necessary stents or other procedures. Proper treatment can relieve PAD symptoms, slow the progression of the disease, and improve the health of the arteries not just in your legs but throughout your body. This will allow you to live longer with a lower risk of heart attack and stroke.

Lifestyle & Medication

All women with PAD will be advised to make healthy lifestyle changes:

  • Eat a heart-healthy diet low in saturated fat and cholesterol. Get plenty of whole grains, vegetables, and fruits.
  • Exercise regularly (at least 30 minutes a day 5 or more days a week)
  • Control your weight if you are overweight or obese
  • Quit smoking
  • Control your diabetes—blood sugar control and proper foot care are especially important in women with PAD

Women with PAD, especially those with claudication pain, may also benefit from a supervised exercise program to improve walking ability and quality of life.9,10 See Exercise and Lower Extremity PAD Rehabiliation (coming soon) for more.

Lifestyle changes can go a long way, but you may also need medication to control high blood pressure and drugs such as statins to lower your cholesterol. Most women with PAD should also take daily aspirin to prevent blood clots; talk to your doctor before starting an aspirin regimen. Some women with other conditions that put them at high risk for blood clots may need to take additional blood thinning drugs.

In addition to medication to control your risk factors, medicines such as cilostazol may be able to improve your walking ability.

Further Treatment

For many women, lifestyle changes and medications are enough to improve PAD symptoms and reduce the chances of future problems. However, if you have severe symptoms caused by arteries that are very narrowed or blocked you may benefit from procedures to open the arteries.

Procedures that may be used to treat more severe cases of PAD include:

  • Angioplasty or stent placement – a long thin tube called a catheter is inserted into an artery in your leg and guided to the affected artery. The artery is opened with a balloon, and a small wire mesh tube may be left in the artery to prop it open
  • Peripheral artery bypass surgery - a blood vessel from another part of your body is used to make an alternate path for blood to flow around a blocked artery, much like bypass surgery to treat coronary artery disease
  • Amputation - in the most severe cases, removing part of your foot or leg may be the only option to prevent potentially deadly complications of PAD. If you identify and treat your PAD early, this is rarely necessary.

See our Overview of PAD Treatment (coming soon) for much more on the different treatments for PAD and how well they work in women.

How can I prevent PAD?

Many of the lifestyle changes recommended to prevent PAD from getting worse may also prevent PAD in women who have not developed it. A heart-healthy lifestyle that includes a healthy diet and regular exercise can prevent PAD and other forms of heart and blood vessel disease, including heart attack and stroke.

You should also work with your doctor to identify characteristics or conditions that are putting you at risk for PAD and take steps to get them under control, including:

  • Quitting smoking
  • Controlling your weight
  • Controlling high blood pressure
  • Lowering your LDL cholesterol
  • Talk to your doctor about medications to prevent blood clots
  • If you have diabetes, manage your blood sugar levels and practice proper foot care
  • Take good care of your feet. Inspect them every night, particulary between the toes and on the heels.

See Preventing PAD: The Basics (coming soon) for more on steps you can take to protect your arteries and prevent PAD.

Information on other Types of PAD

The term "Peripheral Artery Disease" includes disease in all the arteries outside the heart, including those that supply blood to the brain and other organs. For information on artery disease other than the lower limbs, see these other articles on our site:

  • For information on disease in the arteries that supply the brain, see Carotid Artery Disease. See our Stroke section for information about blood vessel disease in the brain and its complications.
  • For information on disease of the renal arteries that supply blood to the kidneys, see Renal Artery Disease.
  • See Aortic Disease for information on disease of the large artery that carries blood away from the heart and distributes it to the rest of the body.

Learn More

Coming Soon:

  • The treatment options for PAD and how well they work in women
  • How rehabilitation can help your recovery from PAD and prevent future problems
  • Tips on living with PAD
  • Links to PAD organizations, support groups, and other useful resources

References

  1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. March 21, 2006 2006;113(11):e463-465.
  2. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 27 2009;119(3):e21-181.
  3. Allison MA, Ho E, Denenberg JO, et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. Apr 2007;32(4):328-333.
  4. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. Sep 19 2001;286(11):1317-1324.
  5. Hirsch AT, Murphy TP, Lovell MB, et al. Gaps in Public Knowledge of Peripheral Arterial Disease: The First National PAD Public Awareness Survey. Circulation. October 30, 2007 2007;116(18):2086-2094.
  6. Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol. Feb 1998;18(2):185-192.
  7. Fowkes FG, Housley E, Riemersma RA, et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol. Feb 15 1992;135(4):331-340.
  8. Beks PJ, Mackaay AJ, de Neeling JN, de Vries H, Bouter LM, Heine RJ. Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn study. Diabetologia. Jan 1995;38(1):86-96.
  9. Keo H, Grob E, Guggisberg F, et al. Long-term effects of supervised exercise training on walking capacity and quality of life in patients with intermittent claudication. Vasa. Aug 2008;37(3):250-256.
  10. McDermott MM, Ades P, Guralnik JM, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. Jan 14 2009;301(2):165-174.

Filed in Cardiovascular Disease > PVD


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